Speaker 1: Pushkin. Hi everyone, Doctor Poyter here, I'm popping in to
Speaker 1: let you know that we're working on a special episode
Speaker 1: of Decoding Women's Health. We're i'll be answering your questions
Speaker 1: about one of my favorite topics, hormone therapy. If you've
Speaker 1: been wondering about the different types of therapy, when it
Speaker 1: might make sense to start possible side effects? Are really
Speaker 1: anything else? This is your chance to ask. You can
Speaker 1: leave us a voicemail at four FI five two one
Speaker 1: three three eight five, or send an email to Decodingwomen's
Speaker 1: Health at Pushkin dot fm and let us know if
Speaker 1: you'd like to stay anonymous, or if you're up for
Speaker 1: having your voice featured on the show. I'm so excited
Speaker 1: for this one. Hormone support is such a misunderstood area
Speaker 1: of medicine, and there's a ton of new and fascinating
Speaker 1: research to talk about together. I can't wait to hear
Speaker 1: what you're curious about.
Speaker 2: Our first paper. They said, aren't you worried that these
Speaker 2: are people who are just looking to be high but
Speaker 2: stay within the limits of the law. No, I'm not,
Speaker 2: because most people that I deal with do not want
Speaker 2: to be intoxicated. We have a clinical trial for endometriosis.
Speaker 2: And the very first thing almost every one of them
Speaker 2: has said to me is it's not going to get
Speaker 2: me high, right, first thing, end of the box. Because
Speaker 2: people have whole lives. They have work, they have children,
Speaker 2: they have activities, they have partners, they have school lunches,
Speaker 2: they have dinner dates, they have things. They don't want
Speaker 2: to be high all day, every day.
Speaker 1: Welcome to Decoding Women's Health. I'm doctor Elizabeth Poynter, and
Speaker 1: today on the show, we're talking cannabis. You know, medical
Speaker 1: marijuana first came on my radar about ten years ago
Speaker 1: when it first became legal in the states where I practiced.
Speaker 1: That meant as a doctor and as a surgeon, I
Speaker 1: had another treatment option to explore for my patients who
Speaker 1: were dealing with pelvic pain, endometriosis, and other chronic pain issues.
Speaker 1: The patients that I referred to medical dispensaries generally had
Speaker 1: positive experiences, and over time, more and more of the
Speaker 1: women I treated began sharing that they were using cannabis
Speaker 1: for other conditions, not just for their pain, but also
Speaker 1: for psychological issues like anxiety and depression. This was many
Speaker 1: years ago now, and so much has changed. Access to
Speaker 1: these products has exploded in recent years as more states
Speaker 1: legalized both recreational and medical marijuana. So before recording today's interview,
Speaker 1: I did some homework. I reviewed the latest medical cannabis
Speaker 1: research from top journals, and for the very first time,
Speaker 1: I visited my own local dispensary. It was totally overwhelming.
Speaker 1: There were so many options. The sales representative or bud
Speaker 1: tender as I learned that she was called, was kind
Speaker 1: and tried to be helpful, but she seemed to struggle
Speaker 1: to answer some of the more specific questions that I
Speaker 1: had about what products might be the best for certain
Speaker 1: symptoms and conditions. For many women, and exploring this world
Speaker 1: for the first time, I can totally see how it
Speaker 1: might be very difficult to know what to ask for
Speaker 1: or how to proceed safely in a way that addresses
Speaker 1: your individual health needs. Fortunately, today we have an exceptional
Speaker 1: guide to walk us through all of this. My guest
Speaker 1: is doctor Stacey Gruber. She's a neuroscientist and an international
Speaker 1: expert on the health effects of marijuana. This made me
Speaker 1: do a deep dive into the science of the connabinoid pathway.
Speaker 2: Super curious here and it's constantly changing what we know
Speaker 2: today is different from what we'll know tomorrow. You know,
Speaker 2: people used to think these things worked one way, and
Speaker 2: they don't. So there's never a dumb moment.
Speaker 1: That's the great thing about science. If you believe in science,
Speaker 1: I agree with you. Yes, yeah, that's a whole another episode.
Speaker 1: Doctor Gruber is the creator and the director of the
Speaker 1: Marijuana Investigations for a Neuroscientific Discovery, or the MIND Program,
Speaker 1: at McClain Hospital. She's also in a so Sociate Professor
Speaker 1: of Psychiatry at Harvard Medical School. The overarching goal of
Speaker 1: her research is to understand how medical cannabis affects individuals
Speaker 1: over time. She and her team study how cannabis use
Speaker 1: influences things like anxiety, depression, sleep, chronic pain, and reliance
Speaker 1: on other medications. They began observing people before they start
Speaker 1: using medical cannabis and then follow their progress for months
Speaker 1: and sometimes years to see how things change.
Speaker 2: In twenty fourteen, I launched the MIND Program because in
Speaker 2: twenty twelve, Massachusetts was on the precipice of legalizing cannabis
Speaker 2: for medical purposes, or I should say relegalizing cannabis was
Speaker 2: legal in this country. Was part of our US pharmacopeia
Speaker 2: it fell out of favor, became illegal, landed in the
Speaker 2: most restrictive class of the Controlled Substance Act. But in
Speaker 2: nineteen ninety six it was reintroduced in California for medical
Speaker 2: purposes and reapproved. So in twenty twelve, Massachusetts was about
Speaker 2: to approve cannabis for medical purposes, and I decided, let's
Speaker 2: look at the literature and see what we know about
Speaker 2: the long term effects of medical cannabis use. Scouring the literature,
Speaker 2: I found almost nothing, and so that's why I launched
Speaker 2: this program. There has never been a program dedicated to
Speaker 2: looking at the long term impact of medical cannabis use,
Speaker 2: despite the fact that it was relegalized in California in
Speaker 2: nineteen ninety six. Almost everything we know about cannabis has
Speaker 2: come from studies of recreational consumers, primarily young, healthy recreational consumers,
Speaker 2: and that's a bit of a problem. In fact, it's
Speaker 2: a huge problem. Individuals who are using for recreational purposes
Speaker 2: by design, are looking for products with notable THHC or tetrahydrocannabinol,
Speaker 2: the primary intoxicating constituent of the plant. In contrast, our
Speaker 2: medical cannabis patients aren't necessarily looking for that same experience.
Speaker 2: In fact, many will tell you I don't want to
Speaker 2: be altered or high. As a result, it's very challenging
Speaker 2: to really understand what the actual impact is on so
Speaker 2: many of these indications and conditions that people will swear uptown,
Speaker 2: left and right cannabis or cannabinoids are effect before. So
Speaker 2: since twenty fourteen, we've spent a lot of time doing
Speaker 2: longitudinal observational studies as well as some cross sectional studies
Speaker 2: and some survey studies, but mostly focused on the what
Speaker 2: is considered the holy grail getting to the clinical trial models,
Speaker 2: which is where we are.
Speaker 1: So it sounds like patients originally led you to look
Speaker 1: at cannabis. What particular aspect of it drew you into
Speaker 1: looking at cannabis other than the kind of lack of data.
Speaker 1: Was it you saw efficacy? Did you see people getting
Speaker 1: better using recreational cannabis? What did you observe that drew
Speaker 1: you into this area of research.
Speaker 2: So the first thing I would say is that going
Speaker 2: back to the sort of recreational days when I was
Speaker 2: still spending a lot of time in more general psychiatry,
Speaker 2: I noticed a very interesting trend. We spent a lot
Speaker 2: of time looking at patients with bipolar disorder, and I
Speaker 2: would hear patients say, you know, when I feel like
Speaker 2: I'm spiraling out of control, I take a few hits
Speaker 2: and I feel better. On the other side, you'd hear
Speaker 2: patients say, I feel so depressed and down. I take
Speaker 2: a few hits. I feel better. I had never heard
Speaker 2: of anything like this, and so this got me thinking,
Speaker 2: so we did a study. I wrote a grant to
Speaker 2: look at mood changes in individuals with bipolar disorder pre
Speaker 2: and post cannabis use, and we gave people little devices
Speaker 2: to chart their mood after every time they used cannabis
Speaker 2: and three other times a day. And we found that
Speaker 2: individuals with bipolar disorder who used cannabis actually had greater
Speaker 2: mood relief, if you will, from their symptoms relative to
Speaker 2: those patients with bipolar disorder who didn't use cannabis. What
Speaker 2: I was hearing was really individuals saying that they felt
Speaker 2: more stable.
Speaker 1: So it was working on both the manic side of
Speaker 1: the bipolar and the depressive side.
Speaker 2: It seemed too for certain people. So that got me thinking,
Speaker 2: how could something both provide relief from feeling hypomanic or
Speaker 2: manic and give you more of a little bit of
Speaker 2: a lift if you're feeling depressed. And I was desperate
Speaker 2: to understand how both could be true, how can we
Speaker 2: harness some of these things? And that's really how it began.
Speaker 2: And the truth is, cannabis is a remarkable plant with
Speaker 2: over five hundred compounds. You know, we have this tendency
Speaker 2: to say cannabis and we refer to any and all
Speaker 2: things the plant. But it's a missoe we shouldn't do that.
Speaker 2: It's not one thing and it's not one size fits all. Yeah,
Speaker 2: let's dig into that a little bit. Let's do cannabis
Speaker 2: one oh one for our listeners. Okay, so, can you
Speaker 2: just briefly explain the difference between cannabis and hemp, and
Speaker 2: cannabis and cannabinoids and kind of the important components, and
Speaker 2: just give us an overview of cannabis one oh one
Speaker 2: what we need to know cannabis one on one. I
Speaker 2: guess I would start by saying that Cannabis sativa l.
Speaker 2: The plant is remarkably complex. It is comprised of over
Speaker 2: five hundred compounds. Some of these are phytocannabinoids, things from
Speaker 2: the plant that interact with our own system of chemicals.
Speaker 2: Receptors throughout the brain and body the endocannabinoid system. These
Speaker 2: are things like delta nying THHC or tetrahydric canabinol, the
Speaker 2: primary intoxicating constituent of the plant that our recreational folks
Speaker 2: are desperate to find. No judgment, We're fine with them.
Speaker 1: That's what makes us high, right, The THHC.
Speaker 2: That's what makes you high, exactly, So primary intoxicating constituents
Speaker 2: of the plant. Cannabi diol or CBD is a primary,
Speaker 2: but not the only, non intoxicating constituent of the plant.
Speaker 2: Often touted for medical benefits.
Speaker 1: CBD is an anti inflammatory, right.
Speaker 2: CBD is touted for its anti inflammatory actions. It's also
Speaker 2: got lots of other actions, but yes, it's one of them.
Speaker 2: But there are literally dozens and dozens of other cannabinoids
Speaker 2: that we spend time focusing on. There are also things
Speaker 2: like terpenes, the essential oils that give cannabis its characteristic
Speaker 2: scent and flavor profile. These essential oils, by the way,
Speaker 2: present in every plant, have their own biobehavioral health effects.
Speaker 2: As it turns out, flabinoids waxy penal. So the plant
Speaker 2: is complex. It's not just THHC and CBD, as people
Speaker 2: will often pretend a whole plant. Full spectrum product contains
Speaker 2: everything from the native plant that made the product, so
Speaker 2: that's THC, cbd, any and all cannabinoids, terpenes, flabinoids, everything.
Speaker 2: A broad spectrum product is identical except that it has
Speaker 2: no quantifiable amounts of THHC present, again the primary intoxicating
Speaker 2: constituent of the plant. There are some people who, for
Speaker 2: legal or health reasons, cannot have any exposure to delta
Speaker 2: nine THHC, So broad spectrum products are like full spectrum products,
Speaker 2: except they don't contain quantifiable amounts of THHC. Hemp is
Speaker 2: a variety of cannabis with inherently low levels of delta
Speaker 2: nine THHC. It's often referred to as industrial hemp because
Speaker 2: it was used for industrial purposes. These are basically at
Speaker 2: this point excluded from the Controlled Substance Act, which means
Speaker 2: that products that are created from hemp are not under
Speaker 2: the same federal jurisdiction. That is, they are not federally illegal.
Speaker 2: If you will, as cannabis or quote marijuana is, can you.
Speaker 1: Speak to us a little bit about delivery systems, I mean, smoking, vaping,
Speaker 1: edible vaginal suppositories for pelvic pain s.
Speaker 2: Yes, all the above. Root matters. Think of it as
Speaker 2: a GPS like, it matters which way you go. So
Speaker 2: the fastest way to get an effect from using cannabis
Speaker 2: is or a cannabinoid based product is what I would
Speaker 2: call a root of inhalation, right, so either smoking or vaping,
Speaker 2: so we inhale, it goes into the lungs, into the bloodstream,
Speaker 2: into the brain. That's what I would call moments to
Speaker 2: minutes to get an effect. We use a sublingual delivery
Speaker 2: system for all of our clinical trials because the area
Speaker 2: just under the tongue, the salibary mucosa, is incredibly rich
Speaker 2: and absorbent, and instead of waiting for you to swallow
Speaker 2: something and digest it, which we're going to get to
Speaker 2: in a second, with edibles, your body can actually use
Speaker 2: it much more effectively, much more quickly. Edibles, whether that's
Speaker 2: a brownie or a cookie, or a candy, or even
Speaker 2: a beverage, although beverages are slightly faster anting than cookies
Speaker 2: and brownies. So this is the type of product that
Speaker 2: people are often very happy to explore. They think it's
Speaker 2: going to be terrific and they eat it or they
Speaker 2: drink it, and they wait what they feel is an
Speaker 2: appropriate amount of time, they don't feel anything, and then
Speaker 2: they have more. It takes a very long time, comparatively speaking,
Speaker 2: for you to get an effect from an edible or
Speaker 2: consumed product. That's because you have to digest it. Interestingly,
Speaker 2: cannabinoids are processed then by the liver. Your liver process
Speaker 2: is all compounds, all drugs, right, and things like delta
Speaker 2: nine THHC. The primary intoxicating considering of the plant is
Speaker 2: actually converted to something even more intoxicating, eleven hydroxy. I
Speaker 2: always tell people hold on root of administration is important.
Speaker 2: If you're eating it, you have to give yourself plenty
Speaker 2: of time to feel the effect and to recover from
Speaker 2: the effect. Isn't the same as smoking or vaping, where
Speaker 2: it's almost immediate.
Speaker 1: Any damage to the lungs with us smoking. So you know,
Speaker 1: there's a lot of dispute about this, and the twenty
Speaker 1: seventeen Nason Report, the National Academies of Science Engineering in
Speaker 1: Medicine looked at what indications or conditions there might be real,
Speaker 1: substantial or moderately significant evidence for it with regard to
Speaker 1: cannabis being efficacious, and they did review things like head
Speaker 1: and neck cancers, and the rates were not significantly higher necessarily.
Speaker 1: I think it's early still to figure that out. And
Speaker 1: really most people acknowledge that the amount of cannabis that
Speaker 1: people are smoking or vaping and the ways in which
Speaker 1: they're doing it may be very different from things like
Speaker 1: cigarette smoking, So maybe that's one of the differences. But
Speaker 1: there's lots of debate about the carcinogenic compounds and what's contained,
Speaker 1: so I think we don't know the whole story yet
Speaker 1: for sure. But there are people who would prefer to
Speaker 1: use a root of inhalation, so smoking or vaping. Dabbing,
Speaker 1: of course, is another where people take a very very
Speaker 1: concentrated Bullus concentrates are exactly as their name suggests, designed
Speaker 1: to give the consumer or patient a big bang for
Speaker 1: the buck. These are primarily THHC focused and start at
Speaker 1: about forty five or fifty percent PhD and go north
Speaker 1: of ninety nine percent. How do you dab?
Speaker 2: So, in the case of an actual quote dab this
Speaker 2: little blob of very concentrated product, you actually need something
Speaker 2: that you can get very very hot with a blowtorch.
Speaker 2: It doesn't look anything like conventional cannabis.
Speaker 1: Use.
Speaker 2: Like when we think about people passing a blunt or
Speaker 2: a spliff or a joint or something, or a bong.
Speaker 2: You see people with a little blowtorch and a little
Speaker 2: flat area. They get very very hot, and as soon
Speaker 2: as they put this little tiny blob of very concentrated
Speaker 2: product on it, they inhale. They get this giant bulus
Speaker 2: all at once. Then we get to the you know
Speaker 2: sort of we had the oromycoastal or transmucostal. So things
Speaker 2: like suppositories vaginal or rectal people are using for more
Speaker 2: localized relief, and they do seem to be efficacious for
Speaker 2: some folks. For some things, we never see recreational folks
Speaker 2: using suppositors. I will tell you if you had to
Speaker 2: come across a recreational purssses, yeah, that's my favorite way.
Speaker 2: Now nobody says that.
Speaker 1: No, how about for enhancement of sexual pleasure? Do you
Speaker 1: see that? Yes, vaginal suppositories.
Speaker 2: I think vaginal suppositories began as a way of increasing
Speaker 2: pleasure and increasing lubrication and decreasing discomfort from many many
Speaker 2: individuals who are having any kind of discomfort around sex.
Speaker 2: And it was also initially tattered as a way of
Speaker 2: you know, sort of getting yourself in the mood. But
Speaker 2: at this point we certainly see a number of products
Speaker 2: in the marketplace designed to address or ameliorate symptoms relative
Speaker 2: to meastural related discomfort or other types of discomfort, as
Speaker 2: well as enhancing sexual pleasure. And then there's the daily
Speaker 2: suppositories for women quote of a certain age. As time
Speaker 2: marches on, right, lots of people experience the things like
Speaker 2: vaginal dryness, so some of these oppositors are used on
Speaker 2: a daily basis, or oils are used.
Speaker 1: So what are you finding And let's just speak a
Speaker 1: little bit about midlife women, right, do you see a
Speaker 1: number of midlife women using cannabis for medical reasons and
Speaker 1: not recreational reasons? And if they are, what are they
Speaker 1: using it for? Hot flashes, mood disruptions, sleep anxiety.
Speaker 2: So the answer to both those questions is yes, yes,
Speaker 2: and yes. The top three indications for medical cannabis use
Speaker 2: across the country are chronic pain, mood or anxiety, and
Speaker 2: sleep disruption. Not surprisingly, these are the three top conditions
Speaker 2: we hear about in individuals who are either perimenopausal or postmenoposal,
Speaker 2: so that's not a surprise. Individuals are increasingly interested in
Speaker 2: using cannabis or cannabinoid based therapies to help because they
Speaker 2: have very limited treatment options currently and very limited clinical response.
Speaker 2: As it turns out, those who get clinical response from
Speaker 2: certain conventional medications often complain about side effects, and the
Speaker 2: cannabis or cannabinoids they may be able to reduce or
Speaker 2: completely eliminate that aspect from the equation, which is pretty amazing.
Speaker 1: So you started the Mind program, you have the Women's
Speaker 1: Health Initiative within the Mind program. Can you tell me
Speaker 1: what kind of questions you're trying to answer with that?
Speaker 1: What are your goals? Where are you moving with that?
Speaker 2: I didn't realize what a vastly understudied population we are.
Speaker 2: I didn't. I really didn't. I didn't think about it.
Speaker 2: You know, in psychiatry we think about things that are
Speaker 2: disproportionately higher in women than men, like anxiety disorders. Right,
Speaker 2: things like dementia occur in women more often than in men.
Speaker 2: We have all of these things that we need to
Speaker 2: be mindful of. Guide Ecologic pain, by the way, affects
Speaker 2: over one billion with a b B one billion, and
Speaker 2: we do relatively little, or we've had relatively little in
Speaker 2: terms of these giant discoveries in terms of allowing people
Speaker 2: to be better and not just feel better, but actually
Speaker 2: be better. Women or the Women's Health Initiative at MIND
Speaker 2: was a program that was dedicated to looking at conditions
Speaker 2: or disorders that either disproportionately or exclusively affect women or
Speaker 2: some non binary folks. Because there's so little work.
Speaker 1: In this area, Stay right there. We've got lots more
Speaker 1: from my conversation with doctor Stacey Gruber. Coming right up,
Speaker 1: Can you describe a little bit about the endocannabinoid pathway
Speaker 1: in the human body and how cannabisc and CBD are
Speaker 1: impacting these pathways?
Speaker 2: Sure, I would say it very sort of. The overarching,
Speaker 2: you know, ten thousand foot summary is that every mammal
Speaker 2: has an endocannabinoid system, highly understudied, highly undervalued, and its
Speaker 2: whole purpose really is what we call homeostasis. We're keeping
Speaker 2: things in balance, in check, mood, appetite, pain, all of
Speaker 2: these things are impacted by the end cannabinoid system, and
Speaker 2: it's comprised of these chemicals and receptors. And for chemicals,
Speaker 2: they're our own cannabinoids. En do cannabinoids, and we have
Speaker 2: receptors including CB one and CB two receptors. CB one
Speaker 2: receptors primarily throughout the central nervous systems, CB two receptors
Speaker 2: throughout the periphery. And it appears that THHC is really
Speaker 2: a very very strong agonist, that is, it binds very
Speaker 2: effectively to CB receptors.
Speaker 1: So the CB two receptors are all throughout our body, correct,
Speaker 1: not just our central nervous system.
Speaker 2: Throughout the periphery, right, So you know, you see CB
Speaker 2: two receptors sort of everywhere else a few in the brain,
Speaker 2: but not like CB one receptors, And that may be
Speaker 2: one of the reasons that initially people were rather stunned
Speaker 2: to see that things like Crohn's disease, INFLAMMATORID bowel disease
Speaker 2: were responsive to different types of cannabinoid based therapies. Not all,
Speaker 2: not all cannabinoids are created equally, and we have to
Speaker 2: be mindful with some actions come reactions, and so it's
Speaker 2: very important to know which cannabinoids for which types of indications,
Speaker 2: in which patient populations. And until relatively recently, we were
Speaker 2: under the impression that cannabidial or CBD also must exert
Speaker 2: its effects through the CB one and CB two receptors.
Speaker 2: As it turns out it's not true. It appears that
Speaker 2: CBD modulates its effects through five ht one A or
Speaker 2: serotonin receptors, other chemical and receptor systems. So it's really
Speaker 2: very easy to understand then how you get a bigger
Speaker 2: bang for the buck with more quote players on the field.
Speaker 2: If you're involving more than one receptor subtype and chemical
Speaker 2: messenger system, you're going to get more of a response.
Speaker 2: Right and medical school, we don't spend a ton of
Speaker 2: time thinking about the endocannabinoid system. Nobody hears about it,
Speaker 2: but it turns out to be incredibly important. Again, when
Speaker 2: I think of it, I think as keeping everything in balance,
Speaker 2: your ability to keep things at status. Quote, that's its
Speaker 2: entire goal. That's the endocannabinoid system.
Speaker 1: Can you just give us a broad overview of how
Speaker 1: cannabis is impacting the brain for an axiolytic effect or
Speaker 1: a pain of fact and that type of thing, like
Speaker 1: what is it actually doing in the central nervous system
Speaker 1: to help our anxiety, to help our pain?
Speaker 2: I think that the jury is absolutely still out with
Speaker 2: regard to the specific absolute mechanisms, because so many different
Speaker 2: types of products wind up being efficacious, and those different
Speaker 2: types of products have different constituent profiles, and so you
Speaker 2: can't necessarily know exactly. Okay, well, we know it's this
Speaker 2: receptor system in this one of this one, and I
Speaker 2: tend to think of us as being comprised of dials
Speaker 2: and not switches, right, what we really want to do
Speaker 2: in individuals who are anxious, and I will tell you
Speaker 2: in general, when we can allow people to take an
Speaker 2: emotional breath dial down that master gain. Everything begins to
Speaker 2: fall into place. And so I think of all of
Speaker 2: these things, whether it's anxiety or some of the other
Speaker 2: mood related symptoms, but particularly for anxiety, it would appear
Speaker 2: that higher levels of CBD being administered in our case
Speaker 2: sublingually where people are holding for two full minutes, that's
Speaker 2: the secret two full minutes multiple times a day, very
Speaker 2: low to no levels of depending on what we're doing,
Speaker 2: we do tend to see this down regulation right of
Speaker 2: this hyper responsive activity. The real data will come when
Speaker 2: we can actually look at the underlying change in what
Speaker 2: we call endocannabinoid tone. So when you can take samples
Speaker 2: of individuals before they use these products and then follow
Speaker 2: them over time and look at how that changes, we'll
Speaker 2: have a better sense of exactly what's happening, but I
Speaker 2: like to think of it as again turning down this
Speaker 2: unbelievable response system. And people with real anxiety will tell
Speaker 2: you it is paralyzing. They can't get out of it,
Speaker 2: they can't stop ruminating, and so this ability to sort
Speaker 2: of allow them to shift cognitive set is hugely life changing.
Speaker 1: I'm definitely going to steal that we're made of dials,
Speaker 1: not switches, because I think in modern medicine and pharmacology,
Speaker 1: we think we're going to turn this pathway off or on,
Speaker 1: flip it off or on, and it's not. It's an
Speaker 1: adjustment in multiple pathways and dials. I would like to
Speaker 1: ask you about cognitive health because that is one of
Speaker 1: the concerns obviously with younger individuals who are using cannabis.
Speaker 2: Those are the kinds of questions we started off asking.
Speaker 2: I was very interested in understanding the cognitive changes that
Speaker 2: we might see in individuals who are using medical cannabis.
Speaker 2: We spent decades documenting cognitive decrements associated with recreational cannabis use,
Speaker 2: particularly in those who began using cannabis regularly or consistently
Speaker 2: early prior to age sixteen. Not surprising because again, the
Speaker 2: brain is nerd, developmentally vulnerable, or as I like to
Speaker 2: say to my cannabis audiences, half baked. Right, the brain
Speaker 2: is under construction, not vulnerable just to cannabis, but to
Speaker 2: other substances alcohol, injury, illness, just vulnerable. And my question
Speaker 2: was for those who are beginning medical cannabis use, who
Speaker 2: are adults beyond this period of vulnerability, would we see
Speaker 2: the same decrements? And I will cut to the chase
Speaker 2: and give you a spoiler alert and tell you absolutely
Speaker 2: we do not see that, which is amazing. It is
Speaker 2: not what people think.
Speaker 1: So the brain develops to what age like, where are
Speaker 1: we most vulnerable to alcohol and cannabis?
Speaker 2: Yes, Interestingly, we used to think that the brain was
Speaker 2: quote done by the time we hit puberty. This is
Speaker 2: long ago and far away, and we now know that
Speaker 2: the brain continues to develop throughout the second and into
Speaker 2: the third decade of life. And so when we see
Speaker 2: individuals who are using cannabis regularly that are you know,
Speaker 2: let's say, age fourteen or fifteen, that may wind up
Speaker 2: looking very different in terms of a cognitive profile, maybe
Speaker 2: a clinical profile for sure, in terms of brain structure
Speaker 2: and function relative to someone who began using much later
Speaker 2: in life. That's a really important finding.
Speaker 1: What's the data on cognitive health and older individuals and
Speaker 1: brain health in terms of cannabis use.
Speaker 2: We're just starting to get some of that data on individuals,
Speaker 2: let's just say from midlife on over the age of
Speaker 2: forty forty five. And you know, I used to move
Speaker 2: that line depending on where the number was and where
Speaker 2: I was just kidding, But the truth is, it looks
Speaker 2: very different if you begin to use cannabis later in
Speaker 2: life as opposed to when you are again neurobiologically or
Speaker 2: or neurodevelopmentally vulnerable. Our data suggests that in individuals that
Speaker 2: we see over the course of one year, and we
Speaker 2: take people again, we look at them at baseline and
Speaker 2: we give them a whole neurocognitive battery, and we do
Speaker 2: the same thing at three months, six months, twelve, fifteen, eighteen,
Speaker 2: twenty four, and now we go out for years and
Speaker 2: even just looking at baseline to one year. When we
Speaker 2: think of recreational cannabis ues and what we know, especially
Speaker 2: from young folks, we generally see these frontal executive decrements,
Speaker 2: so the ability to inhibit an inappropriate response, for example,
Speaker 2: the hallmark of somebody who is let's say mature versus
Speaker 2: somebody who is not When we're coming along and we're
Speaker 2: in our teens. Unfortunately, our frontal cortex isn't necessarily online
Speaker 2: as we age. That's the first part to go. That's
Speaker 2: why babies and old people have trouble with inhibiting, right,
Speaker 2: So they just blurred things out. There was a pre
Speaker 2: clinical study that was done years ago in free groups
Speaker 2: of mice that was really quite stunning. A group of
Speaker 2: juvenile mis let's think of them as adolescents, outperformed middle
Speaker 2: aged and older mice investigators that inserted a tiny little
Speaker 2: pump delivering only THHC. And now the adult let's just
Speaker 2: say middle aged and older adult mice outperformed the young
Speaker 2: mice and the young mice when exposed to THHG in
Speaker 2: the tournament. So the brain is vulnerable to certain types
Speaker 2: of cannabinoids. It doesn't appear that it's the same case
Speaker 2: necessarily for things like CBD, which has been touted as
Speaker 2: potentially neuroprotective. So it's important to understand that age matters.
Speaker 2: What you do and when you do it makes a difference.
Speaker 2: And our folks certainly are not demonstrating decrements across the
Speaker 2: board in frontal executive tasks. And from a brain imaging perspective,
Speaker 2: you know your brain is comprised of gray matter, white
Speaker 2: matter and CSF and gray matters are hard working neurons.
Speaker 2: White matter, you know, this is what connects brain region
Speaker 2: to brain region for good communication. And you want white
Speaker 2: matter to have what we call high integrity or coherence.
Speaker 2: We did a study our medical cannabis pations and what
Speaker 2: we found was that, and again we compare them to
Speaker 2: treatment as usual, folks. What we found is relative to
Speaker 2: baseline with no cannabis on board, we don't see changes
Speaker 2: or decreases in white matter organization or coherence. Over time,
Speaker 2: we see increases that stunned me. Our studies of recreational consumers,
Speaker 2: younger cannabis consumers had lower levels of white matter integrity
Speaker 2: or coherence. We do not see that in adults who
Speaker 2: begin using in midlife. In fact, we see increased white
Speaker 2: matter coherence. This is perhaps the most surprising thing for
Speaker 2: most people.
Speaker 1: So, if a woman wants to explore using cannabis to
Speaker 1: help her health and well being, what are some guidelines
Speaker 1: for her? What should she be aware of? What should
Speaker 1: she ask if she goes into a dispensary, what kind
Speaker 1: of questions? What should she look out for?
Speaker 2: I would say the overarching things to be mindful of,
Speaker 2: like what are the top things you say to people?
Speaker 2: Start low and go slow. As an obvious one, here's
Speaker 2: the thing that people don't know about cannabinoids. Necessarily, you
Speaker 2: can always add, you can take away. Never Once it's in,
Speaker 2: it's in. You can't really throw it up or poop
Speaker 2: it out like it doesn't work that way. It's in, okay.
Speaker 2: And so what we want to be mindful of is
Speaker 2: the root of administration and knowing that you can always
Speaker 2: add to what you've taken. So it's better to err
Speaker 2: on the side of less rather than more until you
Speaker 2: know how you're going to respond to different products, and
Speaker 2: they are different. A gummy created for sleep versus pain
Speaker 2: versus anything else, even by the same company, may very
Speaker 2: well affect you very differently because the constituent profile is different.
Speaker 2: What works for your best friend, your husband, your girlfriend
Speaker 2: may not work for you. That's the other thing to
Speaker 2: be mindful of. Be mindful of the here just try
Speaker 2: this phenomenon.
Speaker 1: Eh.
Speaker 2: I had one patient who said her husband said, oh,
Speaker 2: this is exactly what you need right now. And he
Speaker 2: gave her something that was the equivalent of about fifty
Speaker 2: milligrams of THHC. Look didn't dend well. Low doses of
Speaker 2: THC are generally considered for many people angxiolytic. That is,
Speaker 2: they can help reduce anxiety for the majority of individuals,
Speaker 2: and in fact, at certain levels everyone, THHD can be exogenic.
Speaker 2: That does, it can create or worsen anxiety. So you
Speaker 2: have to be very very careful. And to me, a
Speaker 2: quote small dose is not what other people's small dose is.
Speaker 2: Five miligrams is not a small dose. That's a full dose.
Speaker 2: Governor Hickenlooper and Colorado back in the day twenty twelve,
Speaker 2: proposed ten milligrams of THC per serving. That was dropped
Speaker 2: by Nora Walkoff, the director of NAIDA, the National Institutes
Speaker 2: on Drug Abuse. So what's a small dose in my world?
Speaker 2: Less than one milligram? And people laugh, they go, oh,
Speaker 2: come on, you can't get anything. No, I can get
Speaker 2: activity at a receptor, which is what I'm looking for.
Speaker 1: And then you have to be careful, like if your
Speaker 1: gummy is that ten milligrams are five milligrams and you
Speaker 1: cut it up, you have to make sure it's a
Speaker 1: homogeneous gummy, right, because some of them are not so homogeneous.
Speaker 2: Edibles are the most challenging products in terms of dozing,
Speaker 2: in terms of making sure that you know, if it's
Speaker 2: a batch of brownies that a well intended manufacturer has created,
Speaker 2: does the brownie on the bottom left have exactly the
Speaker 2: same profiles a brownie in the bottom right, I don't know,
Speaker 2: And it depends did you tip the pant? All these
Speaker 2: things matter, and so not to scare anybody, but again,
Speaker 2: start with something small, smaller than small. Start with a
Speaker 2: quarter of what you think you should have, and then
Speaker 2: add don't go the other way because unfortunately I get
Speaker 2: the calls in the middle of the night where people
Speaker 2: are in the emergency group, and that's decidedly unpleasant and
Speaker 2: should be avoided.
Speaker 1: So start low and go slow. And what's right for
Speaker 1: your friend is not right for you, and you've got
Speaker 1: to figure it.
Speaker 2: Out your own. Metabolism affects things. What other products or
Speaker 2: compounds are on board will affect things. Alcohol on board.
Speaker 2: So here's another important fact. We know that in a
Speaker 2: quote fed state, that is, with food in your system,
Speaker 2: cannabinoids have much higher bioavailability. That is, the ability for
Speaker 2: your brain and body to use these compounds. So somebody's
Speaker 2: going out to a club with their friends and they pregame,
Speaker 2: so they're going to drink at home. So what do
Speaker 2: they do. They have like a half a cheese pizza, right,
Speaker 2: something in the gut to help absorb, so they're not
Speaker 2: out of their minds. When you do that with cannabinoids,
Speaker 2: you actually make get I had a much bigger signal
Speaker 2: from the connappenoids, so it's the opposite.
Speaker 1: It's so interesting.
Speaker 2: So when people said I had a full stomach, I'm like, oh, oh.
Speaker 1: Yeah, So more food equals more effect.
Speaker 2: You may get more effect. Yeah.
Speaker 1: I want to pause for a moment here to talk
Speaker 1: more about what we know about mixing cannabis and alcohol.
Speaker 1: Researchers have found that using the two together can worsen
Speaker 1: their effects on thinking and coordination, and alcohol can significantly
Speaker 1: increase THHC absorption. This combination is also linked to more
Speaker 1: risky behaviors. Overall, there hasn't been a lot of research
Speaker 1: in this area yet, so we don't fully understand all
Speaker 1: of the implications, and of course the effects can vary
Speaker 1: a lot depending on how much alcohol you're drinking and
Speaker 1: what kind of cannabis product you're using. So we've talked
Speaker 1: about THC five milligrams being on the low end standard dose.
Speaker 2: Yeah, what about CBD depends on what you're using it for.
Speaker 2: So for some people, at our first clinical trial of anxiety,
Speaker 2: we pitched very low. I based it on a product
Speaker 2: that was being used in San Francisco in the Bay
Speaker 2: Area that had great response, and it was somewhere between
Speaker 2: ten and twelve milligrams per mil of CBD, but a
Speaker 2: whole plant ful spatrum product and very low tcy like
Speaker 2: less than point three milligrams, So it wasn't going to
Speaker 2: get you high necessarily, and that was what I was
Speaker 2: aiming for. But the amount of CBD that you might
Speaker 2: think about using is really dictated by what ails you
Speaker 2: for a mood. You might need less than you would
Speaker 2: for chronic pain. Ourre chronic pain studies start significantly higher.
Speaker 2: Most of my studies now use a whole lot more product,
Speaker 2: a higher concentrated product.
Speaker 1: So it depends back to some practical advice. For a
Speaker 1: midlife woman who may be having perimenopausal symptoms issues or
Speaker 1: menopausal issues worse than perimenopause, many times, start low, go slow.
Speaker 1: What would you recommend to start with.
Speaker 2: I would say systemic administration is generally better. A lot
Speaker 2: of times people are caught up in the topical or
Speaker 2: dermal realms. You know what, I have cramps. I'm just
Speaker 2: going to put some of this salve or this lotion
Speaker 2: of systemic application. Something that you take is likely to
Speaker 2: give you the best response. A root of inhalation is
Speaker 2: the fastest way of getting response, but it's not generally
Speaker 2: the way that most patients want to take quote their medicine.
Speaker 2: Not generally, so I would say again, if you're looking
Speaker 2: to address things like chronic pain, I'm a fan of
Speaker 2: sublingual solutions as opposed to other things, and you really
Speaker 2: want to make sure that whatever you're using. In my
Speaker 2: humble opinion, whole plant broad or whole plant full spectrum
Speaker 2: products are highly efficacious For many things. The individual constituents
Speaker 2: within the product dictate the outcome, So if you're having
Speaker 2: trouble with sleep, might look for something with higher levels
Speaker 2: of CBD and not a huge amount of teaching necessarily,
Speaker 2: sometimes a little is fine.
Speaker 1: After the break, we'll get into safety issues to tell
Speaker 1: how much THHC is really in a product, regardless of
Speaker 1: what the label says, We'll be right back looking for
Speaker 1: another great podcast that decodes women's health. I am so
Speaker 1: excited to introduce you to sex Ed with dB, your
Speaker 1: new go to podcast for smart, science based sex education,
Speaker 1: delivering trusted insights from top experts on sex, sexuality, and pleasure. Empowering, inclusive,
Speaker 1: and grounded in real science. It's the sex ed you've
Speaker 1: always wanted. Each episode, sex Educator dB tackles some of
Speaker 1: the biggest questions in sex, intimacy, and pleasure, and we
Speaker 1: have an episode to share that we think you're going
Speaker 1: to love. This episode asked the question can we make
Speaker 1: sex better? dB shares what the research really says about cannabis, desire, arousal,
Speaker 1: and orgasms. Around to the end of this episode for
Speaker 1: a preview and subscribe on your podcast app of choice
Speaker 1: by searching sex ad with dB, or find the link
Speaker 1: in our show notes. So, for a woman in midlife
Speaker 1: who wants to maybe you feel better, maybe better cognitive function,
Speaker 1: get better sleep, is there an advantage of going to
Speaker 1: a medical dispensary versus going to a recreational dispensary?
Speaker 2: Very often medical products have a significantly lowered tax rate
Speaker 2: associated Very often the same products the plant doesn't care
Speaker 2: what you use it for. By the way, plant doesn't
Speaker 2: care at all. Right, Cannabis is cannabis, But the products
Speaker 2: themselves are tax very differently, and there may be a
Speaker 2: different fund of information from the quote patient care advocates
Speaker 2: or bud tenders that you're talking to. So there are
Speaker 2: different types of products that people should probably be exploring
Speaker 2: if they're interested in having let's say, better sleep versus
Speaker 2: addressing things like chronic pain or motor anxiety. Sometimes it's
Speaker 2: a question of dose with the same type of product,
Speaker 2: and sometimes it's a whole different set of players we
Speaker 2: want on the field. So there are some constituents that
Speaker 2: people don't talk about too often, although now we're seeing
Speaker 2: them more often, like CBN or cannabinol. Actually THHC degrades
Speaker 2: over time and we get high levels of CBN and
Speaker 2: old weed. But CBN has been remarkably effective for some
Speaker 2: people with regard to decreasing sleep latency, so time to
Speaker 2: fall asleep and the ability to have better sleep coherence
Speaker 2: or staying sleep. I think of CBD is helpful for
Speaker 2: coherence and CBN is great for latency, but high CBN
Speaker 2: levels are often helpful for people with sleep disruption and
Speaker 2: it's not really generally considered intoxicating. So different combinations of
Speaker 2: these types of compounds are making their way into the
Speaker 2: marketplace now, which makes me very happy. And it's what
Speaker 2: we do in our clinical trials. We try to create
Speaker 2: products and formulate them so that they're optimized to address
Speaker 2: these different conditions and indications.
Speaker 1: So it sounds like this where is like hypothesis generating
Speaker 1: and then you move into making your own product. Do
Speaker 1: you have your own tinc sure that you're making or
Speaker 1: have made? Is that correct?
Speaker 2: A number of different clinical trials, Each clinical trial generally
Speaker 2: uses a different type of product. If you're looking for
Speaker 2: something for sleep versus focus or concentration versus chronic pain,
Speaker 2: they're going to look different. In our group, we spend
Speaker 2: a lot of time I custom formulate all of our
Speaker 2: products to capitalize on that idea.
Speaker 1: How do women begin to what are safety concerns that
Speaker 1: women should have? What do they need to ask, what
Speaker 1: do they need to what do they need to look
Speaker 1: for to be safe about this? If they want to
Speaker 1: explore using cannabis to relieve some of their symptoms.
Speaker 2: So yeah, for symptom relief, And if that's really clear
Speaker 2: I always tell people no, before you go, be honest
Speaker 2: with yourself and ultimately the people that you're talking with
Speaker 2: or dealing with about what your real goal is. And again,
Speaker 2: no shame in Ah. You know, I'd like to take
Speaker 2: the endge off with my partner on Friday. Fine mazzle,
Speaker 2: but very different from I have this intractable pain. I
Speaker 2: can't move. I really I can't get off the couch.
Speaker 2: I'm really uncomfortable. So label claims have been reported to
Speaker 2: be both under and overstated. So sometimes product will say
Speaker 2: that it has a whole lot more of let's say
Speaker 2: CBD in it than it does, which, by the way,
Speaker 2: is really heartbreaking when you're talking to somebody who's seventy
Speaker 2: eight years old on a fixed income and has spent
Speaker 2: ninety six dollars on a one ounce bottle of something
Speaker 2: that's supposed to be fifty megs per mel and it's three.
Speaker 2: That's a problem. Sometimes they're understated with regard to things
Speaker 2: like THHC, where the individual is going to be exposed
Speaker 2: to a whole lot more THC than they might have anticipated.
Speaker 2: The only way to know really what's in your weed,
Speaker 2: or what's in the product you're using is to ask
Speaker 2: your dispensary or the point of sale if you're buying
Speaker 2: it online, or a certificate of analysis to ensure that
Speaker 2: the product is what they would like it to be.
Speaker 2: Dispensaries have to have them by law, and most reputable
Speaker 2: manufacturers and sellers online will also have coas for all
Speaker 2: of their products by batch, not just the general one
Speaker 2: that sort of represented what they made long ago and
Speaker 2: far away, but the actual product that you're using. You
Speaker 2: should be able to match the batch and look at
Speaker 2: the CoA that will tell you exactly how much of
Speaker 2: each of the compounds is in your product. I would
Speaker 2: remind people that it is not necessarily without its own
Speaker 2: associated concerns or risks. So we think about things like
Speaker 2: drug drug interactions. This is what I call the least
Speaker 2: popular girl at the dance phenomenon. When I bring this up,
Speaker 2: people say, oh, with that already. So here's how it goes.
Speaker 2: Your liver processes all drugs and so. As it turns out,
Speaker 2: cannabinoids impact the liver's enzyme systems. The cytochrome P four
Speaker 2: fifty enzyme system highly impacted by cannabinoids, and in fact,
Speaker 2: CBD affects more of them than DHC so as a result,
Speaker 2: we are very careful with individuals who are on certain
Speaker 2: types of medications because you could wind up inadvertently increasing
Speaker 2: or decreasing the serum level of certain drugs that you
Speaker 2: would not want to do that with. For example, an
Speaker 2: ANTIICOI got a blood fitter. It's not so great to
Speaker 2: increase the amount of blood thatitter coursing through your body.
Speaker 1: No, thank you.
Speaker 2: Women should be mindful of that. It's not completely benign.
Speaker 2: You have to be careful.
Speaker 1: So a number of midlife women may be on SSRIs
Speaker 1: or even hormone replacement therapy so or I call it
Speaker 1: men a puzzle hormone support. Sorry, not HRT. That's old fashion, right,
Speaker 1: we don't say that anymore, right, therapy support? Is there
Speaker 1: any interaction with cannabis.
Speaker 2: So there are some to be mindful of. The best
Speaker 2: thing to do is to go online and actually look
Speaker 2: for the drug drug interaction calculator, and you can put
Speaker 2: in anything you're using. And the reason I wouldn't be
Speaker 2: specific is because then you could misinterpret what I'm saying
Speaker 2: and take it as postulate, and so we don't want
Speaker 2: to do that. But to your point, generally, there are
Speaker 2: a number of conventional medications that are not a concern,
Speaker 2: and then there are a handful that are, and some
Speaker 2: of them appear in certain classes like SSRIs for sure,
Speaker 2: benzodiazepines for sure, anticoagulants or blood thinners, So we want
Speaker 2: to be mindful of that. Hoomone replacement not generally an issue,
Speaker 2: but always best to check with your PCP. But you
Speaker 2: can look at a drug drug int Reaction tool online,
Speaker 2: which is incredibly helpful because sometimes people aren't always forthcoming
Speaker 2: about what they're using. That's the other thing. They don't
Speaker 2: necessarily want to tell their treat that they're using cannabis
Speaker 2: or cannabinoids. And I say this to you if you're
Speaker 2: one of those folks, don't be afraid. If your doctor
Speaker 2: isn't open minded and willing to listen to why you're using,
Speaker 2: what you're getting from it, and your rationale, you may
Speaker 2: want to consider talking to someone else. Let's talk about
Speaker 2: physician education.
Speaker 1: So I'm a pretty curious physician, early adopter of medical
Speaker 1: marijuana twenty twelve, twenty fourteen in New Jersey, New York.
Speaker 1: Good for you, And Demetriosi is pretty curious but know
Speaker 1: very little about this. Know a lot more now, But
Speaker 1: what is the average physician, what is their participation in
Speaker 1: knowledge of these pathways and the impact that cannabis and
Speaker 1: the utility and benefit that it can have for women
Speaker 1: or just patients in general.
Speaker 2: Generally, people are underinformed and they are overwhelmed by the
Speaker 2: headline that will tell you cannabis is terrible for this
Speaker 2: and awful for that, And it's so important to understand
Speaker 2: once again, cannabis is not one thing. It is a
Speaker 2: multi compound plant, so to refer to anything that comes
Speaker 2: from it is foolish. It is also really unfortunately true
Speaker 2: that most don't have the time to educate themselves about
Speaker 2: where it may be most effications, where it may be
Speaker 2: most concerning, or how it may differ from their firmly
Speaker 2: held beliefs. Our patients require it, I mean, really, they
Speaker 2: are looking to us to help make good, sound decisions.
Speaker 2: Those decisions should be based on real data, real science,
Speaker 2: and not rhetoric or your own personal beliefs. I think
Speaker 2: that more and more physicians are interested in understanding it
Speaker 2: because it's coming through the door every day now, and
Speaker 2: it's usually because one of their quote more responsible patients
Speaker 2: has raised the question, and so now they're going to
Speaker 2: dig into it they had a handful before, But you know,
Speaker 2: those people were probably just looking for a legal way
Speaker 2: to be high. I was told the same thing when
Speaker 2: we first started this program. We created a metric in
Speaker 2: our lab called can account, and it allows us to
Speaker 2: quantify the amount of individual cannabinoids that people are exposed
Speaker 2: to on a weekly basis, whether you're using a tincture
Speaker 2: or flower product, or an edible or beverage. There are
Speaker 2: ways that you can calculate it based on both what's
Speaker 2: on the label and a certificate of analysis, how long
Speaker 2: it takes you to use it, how you're using all
Speaker 2: these things. And the truth is when we look at
Speaker 2: the data at three months, six months, and one year,
Speaker 2: overwhelmingly just looking at CBD and THHC levels, CBD is
Speaker 2: exponentially higher than THHC, underscoring the point that these people
Speaker 2: aren't really chasing a high. So it's important for physicians, caregivers,
Speaker 2: healthcare workers, legislators, everybody to sort of let go of
Speaker 2: what we think we know and allow ourselves to be
Speaker 2: open to what the science and the data tell us.
Speaker 2: It's really important to remember and to remind people who
Speaker 2: see patients every day all day to have dialogues and
Speaker 2: not monologues with their patients. This is supposed to be
Speaker 2: a conversation, not me telling you what to do. And
Speaker 2: I think for a long time and still today, people
Speaker 2: are very concerned about losing their license if they were
Speaker 2: to perhaps consider writing a certification for medical cannabis use.
Speaker 2: It's not by prescription. You can't get a prescription for
Speaker 2: scheduled drug, right, So these things are recommendations or certifications.
Speaker 2: And the number of folks that I see who say, yeah,
Speaker 2: I'm not getting into that. I don't want to lose
Speaker 2: my license because when things invariably come around, I don't
Speaker 2: want to be in the crosshairs. So I think a
Speaker 2: lot of it is fear, a lot of it is
Speaker 2: misperception and a lot of misinformation. What do women need
Speaker 2: to know about drug testing? There's definitely professions where there's
Speaker 2: drug testing involved, and you may be using a high
Speaker 2: CBD product that does have some THHC in it. What
Speaker 2: do we need to know about that? We need to
Speaker 2: know a bunch of things first and foremost. When people
Speaker 2: hold up a bottle and they say to mean, look,
Speaker 2: this is just CBD, it's almost never just CBD, and
Speaker 2: that's Okay, from a clinical perspective, we don't want it
Speaker 2: to be just CBD. Whole plant full or whole plant
Speaker 2: broad spectrum. Botics are more efficacious. However, at our very
Speaker 2: first clinical trial that I developed for folks with moderate
Speaker 2: severe anxiety was basically a whole plant full spectrum product
Speaker 2: and it was sourced from cannabis. However, that particular chemo
Speaker 2: ar cultivar that made the base that I then created
Speaker 2: the product from would be termed hemp today. I could
Speaker 2: have used ten times the amount of THHC that I
Speaker 2: had in that product and still been within the limits
Speaker 2: of the law. It had point to two milligrams per
Speaker 2: millileter very low. And what we found was after four
Speaker 2: weeks of a relatively higher CBD containing compound and very
Speaker 2: low THHC, half the sample was positive for THHC after
Speaker 2: four weeks, so they would have filled a drunk test.
Speaker 2: And so people say to me, but Doc, you know,
Speaker 2: it's just this hold on broad spectrum. Products are designed
Speaker 2: to eliminate that possibility from the equation. So civil servants,
Speaker 2: people who are in jobs where they really can't take
Speaker 2: the chance, or who are uber sensitive to THHC. And
Speaker 2: there are many people who are hyper sensitive to THHC
Speaker 2: and very very small amounts are still too much. So
Speaker 2: that's something to be mindful of. Please be mindful of
Speaker 2: what you're using in When it doesn't list how much
Speaker 2: THHD is in the product, ask for a CoA. Any
Speaker 2: and all amounts of THC can aggregate in the body,
Speaker 2: and they do, and you will potentially have a positive
Speaker 2: drug screen.
Speaker 1: How long is the drug string positive for if you've
Speaker 1: ingested some THC.
Speaker 2: Depends on what you're using, how often, and how familiar
Speaker 2: you are with cannabis. So some of our more routine
Speaker 2: users in the old days, the recreational studies that we did,
Speaker 2: these were what I would call heavy hitters. These are
Speaker 2: people who are using multiple times a day. We had
Speaker 2: some folks who are still positive at for forty some
Speaker 2: odd days.
Speaker 1: Do you have any personal experience in improving your own
Speaker 1: health with cannabis? If you do use it, do you
Speaker 1: have any any surprising effects or so?
Speaker 2: I would tell you that not all people have a
Speaker 2: positive relationship with THHC unfortunately, and I'm one of them.
Speaker 2: Is like the plumber whose house has a leak in
Speaker 2: the basement, Maybe THHC and I have a detuont other
Speaker 2: cannabinoids that are non intoxicating. I'm fine with. Some people
Speaker 2: are very very slow metabolizers of certain consiguents like THHC,
Speaker 2: and a very little bit can go a very long way.
Speaker 2: So you have to be very mindful. If I try
Speaker 2: something and it's absolutely fine for me with like one
Speaker 2: milligrammar or a milligram and a half of PC and
Speaker 2: I don't feel altered, no one's going to feel altered
Speaker 2: because it takes very very little. I'm a cheap data.
Speaker 2: As it turns out, if.
Speaker 1: You had to tell women or advise women, what would
Speaker 1: be the one thing that you would say about cannabis
Speaker 1: use and how cannabis can impact their health?
Speaker 2: I think I would probably say that there is unprecedented
Speaker 2: promise with regard to cannabis and cannabinoids for many many
Speaker 2: indications and conditions that affect us. That said, you can't
Speaker 2: believe all the hype, and you have to really educate
Speaker 2: yourself and ask questions. In my very humble opinion, people
Speaker 2: are exploring cannabis and cannabinoid based therapies to reduce their
Speaker 2: use of conventional medications, to sleep better, to have less pain,
Speaker 2: to have better mood and also to have better day
Speaker 2: to day life. If we think of things as a
Speaker 2: natural anti inflammatory or ways of improving your own immune system,
Speaker 2: people are adding these products to their daily health and
Speaker 2: wellness regimens. There are certain cannabinoids likes for sure, CBD,
Speaker 2: but so many others that are the unsung heroes that
Speaker 2: are actually more effective as anti inflammatory or neuroprotective agents
Speaker 2: or all sorts of things we don't have time to
Speaker 2: get into, and so you can create these compounds that
Speaker 2: you might take on a regular basis or have other
Speaker 2: people do it and feel a whole lot better than
Speaker 2: you might otherwise. I've been in situations where I didn't
Speaker 2: recognize the patient when I walked into the waiting room
Speaker 2: because they looked so different from the way they looked
Speaker 2: a month prior. I think we're at the very, very
Speaker 2: beginning stages of what will ultimately be an absolutely unprecedented revolution.
Speaker 2: I mean, we really can change some of the ways
Speaker 2: that people are living. And I had this last week.
Speaker 2: I had a woman say to me, I am for
Speaker 2: the first time in nine years, I'm considering not having
Speaker 2: a hesteractomy because I now know what it's like to
Speaker 2: live without chronic debilitating. I'm at an eight or nine
Speaker 2: out of ten pain all day, every day. What do
Speaker 2: you do with That's that's amazing right.
Speaker 1: Researchers like doctor Gruber are learning more every day about
Speaker 1: how to use cannabinoid based therapy safely and effectively, but
Speaker 1: for now, there are a few key things to keep
Speaker 1: in mind. Start low and go slow. Begin with a
Speaker 1: small dose, even just a quarter of what you think
Speaker 1: you might need, and increase gradually. Be clear about what
Speaker 1: your goal is. Low doses of THHC, the primary intoxicating
Speaker 1: part of the plant, may help with anxiety, but be
Speaker 1: careful because higher levels often trigger anxiety in many people.
Speaker 1: Cannabinoids like CBN and CBD may be helpful for sleep.
Speaker 1: CBD may also be helpful for things like anxiety and inflammation,
Speaker 1: and also has potential neuroprotective qualities. Doctor Grueber has noted
Speaker 1: that there are other cannabinoids that have shown promise with
Speaker 1: regard to anti inflammatory and neuroprotective properties, including CBG, CBC,
Speaker 1: and THCHCB. Look for full or broad spectrum products. These
Speaker 1: formulations take advantage of multiple cannabinoids working together. Full spectrum
Speaker 1: products contain the naturally occurring range of cannabinoids, including THHC, CBD,
Speaker 1: and other minor cannabinoids. Broad spectrum products are similar to
Speaker 1: full spectrum products, with the important distinction that they are
Speaker 1: intended to have no quantifiable amount of THHC. So doctor
Speaker 1: Gruber suggests looking into broad spectrum products if you want
Speaker 1: to avoid feeling altered or high, or if you work
Speaker 1: in a field that drug tests for THHC, and remember
Speaker 1: always check the products certificate of analysis to get more
Speaker 1: accurate information about the compounds that are included in it.
Speaker 1: For interactions. If you're taking other medications, use a reliable
Speaker 1: drug drug interaction tool online to see if cannabis might
Speaker 1: interfere and be honest with your doctor. Let them know
Speaker 1: what you're using or considering. If your provider isn't receptive
Speaker 1: or informed, consider finding someone who is. There are plenty
Speaker 1: of clinicians out there who are curious and excited about
Speaker 1: the medicinal potential of cannabis and who can help you
Speaker 1: figure out what's right for you. Coming up on the
Speaker 1: next episode of Decoding Women's Health will be diving into
Speaker 1: the world of glp ones, a class of drugs that
Speaker 1: has completely changed the conversation around metabolic health and weight loss.
Speaker 3: In the past few decades, we've only been pushing this
Speaker 3: narrative of eating less and moving more, which is oversimplified
Speaker 3: and not the right message. And I think what has
Speaker 3: transformed the landscape of weight management is that now we
Speaker 3: have tools to revillly dress the biology.
Speaker 1: Decoding Women's Health is a production of Pushkin Industries and
Speaker 1: the Atria Health and Research Institute. This episode was produced
Speaker 1: by Rebecca Lee Douglas. It was edited by Amy Gaines McQuaid,
Speaker 1: mastering by Sarah Buguer. Our associate producer is Sonia Gerwit.
Speaker 1: Our executive producer is Alexandra Garreton. Our theme song was
Speaker 1: composed by HANNS. Brown. Concept creative development and fact checking
Speaker 1: by Shavon O'Connor. A special thanks to Alan Tish, David Saltzman,
Speaker 1: Sarah Nix, Eric Sandler, Morgan Rattner, Amy Hagdorn, Owen Miller,
Speaker 1: Jordan McMillan, and Greta Cohne. If you have a question
Speaker 1: about women's health in midlife, leave us a voicemail at
Speaker 1: four F five two O one three three eight five,
Speaker 1: or send us a message at Decoding Women's Health at
Speaker 1: Pushkin dot FM. I'm doctor Elizabeth pointer and thanks for listening.
Speaker 1: Until next time.
Speaker 4: Welcome to sex Ed with dB. I'm your host, dB.
Speaker 4: Let's get into it. Hey everyone, welcome back dB here,
Speaker 4: your favorite sex educator and pleasure expert, and today we're
Speaker 4: talking about cannabis and sex. Now, maybe you've heard people
Speaker 4: say that we'd make sex amazing, or maybe you've tried
Speaker 4: it and thought was that hotter than usual? Or was
Speaker 4: I just way too invested in the way my partner's
Speaker 4: hair smelled because I was super high and it smelled
Speaker 4: so good. Either way, there's a lot of hype and
Speaker 4: a lot of myths around getting high and getting it on.
Speaker 4: So today we are breaking down on what the science
Speaker 4: actually says. As usual, we'll talk about how cannabis might
Speaker 4: affect desire, arousal, and orgasm, why dose matters more than
Speaker 4: you think, and then not so fun side effects that
Speaker 4: you should know before you try it. We'll even dig
Speaker 4: into what researchers have discovered about weed's role in pain
Speaker 4: reduction and sexual satisfaction. And if you've ever wondered whether
Speaker 4: cannabis could take your bedroom game higher or if it's
Speaker 4: just smoke and mirrors. Oh sorry, it's such a bad pun,
Speaker 4: but it's so good you are in the right place.
Speaker 4: So first up, are people who use weed really having
Speaker 4: more sex?
Speaker 2: What do the data show?
Speaker 4: Back in twenty seventeen, researchers at Stanford looked at over
Speaker 4: fifty thousand Americans and found something kind of interesting. Daily
Speaker 4: cannabis users reported having more sex than non users. Women
Speaker 4: went from about six times a month to seven point one,
Speaker 4: and men went from five point six to six point nine. Now,
Speaker 4: before we start just kind of handing out blunts as
Speaker 4: relationship therapy, here's the thing. This is self reported. It's
Speaker 4: not proof that weed causes more sex. It's just that
Speaker 4: people who use it tend to say that they have
Speaker 4: more sex. Could be the weed, could be that people
Speaker 4: who are more open to cannabis are also open to
Speaker 4: other sexual activities. Hard to say, but interesting nonetheless, And
Speaker 4: that leads us nicely into this pleasure piece because even
Speaker 4: if frequency isn't directly caused by cannabis, plenty of people
Speaker 4: swear that it changes how sex feels. In a twenty
Speaker 4: twenty three study with around eight hundred people, over seventy
Speaker 4: percent said that weed made sex better, more desire, more
Speaker 4: intense orgasms, and touch that felt off the chart good.
Speaker 4: Let me repeat that eight hundred people were in this study.
Speaker 4: Over seventy percent said that weed made sex better. So fascinating.
Speaker 4: Hello dB here, thank you so much for listening. If
Speaker 4: you liked what you heard in this clip, you can
Speaker 4: find the rest of this episode and more by searching
Speaker 4: sex ed dB on your podcast app of choice, or
Speaker 4: by heading to sex edi dB dot com.